Basic Information
| Provider Information | |||||||||
| NPI: | 1629234232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | CELESTE | ||||||||
| MiddleName: | NOELL | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BREWSTER BLVD | ||||||||
| Address2: | |||||||||
| City: | CAMP LEJEUNE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285472538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104504750 | ||||||||
| FaxNumber: | 9104503406 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 BREWSTER BLVD | ||||||||
| Address2: | |||||||||
| City: | CAMP LEJEUNE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285472538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104504750 | ||||||||
| FaxNumber: | 9104503406 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2008 | ||||||||
| LastUpdateDate: | 06/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10119 | CO | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | P14555 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.